Matt Shanahan (Waterford, Independent) | Oireachtas source

From one Waterford representative to another, I would like to remind the Minister of State that the Government accepted the recent Regional Group motion on mental health. One of the key requests called for a national lead on mental health issues. I hope the Minister of State can implement that as soon as possible. I also wish to highlight the significant deficiencies in mental health services in University Hospital Waterford, of which the Minister of State will be aware.

Since the beginning of the Covid-19 lockdowns there has been a lot of public discussion on the challenges of mental health and the need for renewed Government emphasis on resourcing and prioritising the sector. The legislation before the House, which seeks to relocate the Central Mental Hospital from the 170-year-old facility in Dundrum to a new purpose-built centre in Portrane in north Dublin, is to be welcomed. The buildings at the current Dundrum premises have been unfit for their modern purposes for many years. They have had capacity and waiting list issues and cannot continue to provide the level or scale of services required of a modern national forensic mental health centre. I refer for example to the Central Mental Hospital's Irish Prison Service remit. A 2019 report noted significant problems with holding prisoners in secure observation cells, sometimes for weeks or months at a time, while awaiting transfer to the Central Mental Hospital. For several years the Irish Prison Service has raised safety concerns about managing mentally ill prisoners while they await transfer to the CMH. The increase in bed capacity at Portrane will add 67 additional beds to the capacity on offer in Dundrum, which is to be welcomed.

Significant questions, however, must be asked. Will this expansion be enough to cover the growing trend of prisoners being found not guilty by reason of insanity in the courts? This fear was expressed by the executive clinical director of the CMH, Professor Harry Kennedy, who has noted that the proposed additional capacity in Portrane might be overtaken in the near future if the present sentencing trends continue. He also points out that Ireland's national forensic mental health service has two secure beds per 100,000 people. Most modern European states have more than ten secure beds per 100,000, five times our national figure. He points out that even with the full complement of 170 beds that is to become operational at Portrane, Ireland's ratio of forensic mental health beds will increase to just 3.5 per 100,000 people, which is still just a third of the average for modern European states. We have to hope that Professor Kennedy's reservations will be assuaged by the Government's stated intention to expand other elements of the National Forensic Mental Health Service at the former St. Ita's Hospital in Portrane.

It has long been observed that a society can be judged by how it treats its most vulnerable. Included in this category are those who have come through the courts and face committal to the Central Mental Hospital. However, society also has a responsibility to all its other citizens to ensure that those requiring such help receive it and that their detention and subsequent release is managed to the highest standards of forensic psychiatric medicine and in accordance with Irish Prison Service rehabilitation protocols.

St. Ita's Hospital is to be legally renamed as the new Central Mental Hospital. I presume the proposed legislation has been rigorously legally reviewed to ensure that those presently resident within the service cannot appeal or interfere in any way with their original committal orders or the duration or terms of their sentences as a result of this change to the legal name, to governance orders or to their place of domicile. One hopes too that the new facilities and environment that inmates will live in at Portrane will help with their treatment and improve their quality of life.

The lawful transfer to and future detention of patients at Portrane, County Dublin, raises another very important issue for Dublin residents, namely, the redevelopment of the Dundrum site after the hospital move. This has long been known as a fashionable and desirable precinct, adjacent to many fine amenity opportunities. The 11.3 ha site at Dundrum must present a very significant opportunity for badly needed housing development. In reviewing the site, the Land Development Agency has suggested that up to 1,300 homes can be created in an entirely new neighbourhood here. Significant financial benefit will accrue to the State as a result of the repurposing of this land. Perhaps the Government should consider ring-fencing a significant portion of this windfall for the future development of forensic mental health services in Ireland. This would signal a changing perspective on the priority of the needs of those resident in the Central Mental Hospital. It would also allow the ethos of providing care, treatment and rehabilitation to mentally ill offenders ,which began in Dundrum 170 years ago, to continue for years to come. With the relocation of the CMH and the possible residential development of the Dundrum site, the State can hopefully close the door on the use of Victorian-era facilities, which are mostly unsuitable for the provision of modern medical services to the people of Ireland.

I hope the proposal being discussed today will deliver significant medical and clinical improvement to the lives of vulnerable and disadvantaged people who may find themselves residents of the CMH. I also hope it will help staff and clinicians to continue to achieve the highest standards of service delivery at the new Central Mental Hospital, the National Forensic Mental Health Service at Portrane, County Dublin. Medical advances in recent months have opened a door where the challenge of Covid-19 is concerned. Hopefully with the opening of the doors at Portrane, we are witnessing a newfound perspective in Government circles, with new priority placed on providing resources to meet the needs of those faced with mental health challenges, regardless of how or where they present.

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